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Minderhout, David, und Andrea Frantz. „Native Americans in the Pennsylvania School Curriculum“. Practicing Anthropology 31, Nr. 1 (01.01.2009): 16–20. http://dx.doi.org/10.17730/praa.31.1.v845722p5pn31007.
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In the 2000 U. S. Census, 18,348 people in Pennsylvania indicated that they were Native Americans, an increase of nearly 50% since 1990; another 34,302 identified themselves as "part-Indian." These numbers likely reflect a trend towards a greater acceptance of Native American status in the United States generally and in Pennsylvania in particular. This trend has been going on since the 1960s with the rise of the Red Power movement, and a changing American society that increasingly saw Native Americans as environmentally friendly and historically wronged. Today, in Pennsylvania, hardly a weekend goes by without a powwow or a tribal gathering somewhere in the state. In our on-going research with Pennsylvania's Native Americans since 2004, we have found them to be both proud of their identity and heritage and increasingly frustrated with the lack of recognition they receive from the state and the larger, non-Indian population. Pennsylvania is one of very few states that neither contains a reservation nor officially recognizes any Native American group. No university-level Native American cultural center or studies program exists within the state, and no state agency is dedicated to the issues and concerns of Native Americans. This is ironic because the first two hundred years of European history in Pennsylvania is one of extensive interaction, cooperation and eventually conflict with Native Americans. But, as will be seen in this paper, Native Americans have largely disappeared from the state history books.
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Geyer, Nathaniel R., und Eugene J. Lengerich. „LionVu: A Data-Driven Geographical Web-GIS Tool for Community Health and Decision-Making in a Catchment Area“. Geographies 3, Nr. 2 (18.04.2023): 286–302. http://dx.doi.org/10.3390/geographies3020015.
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In 2018, the Penn State Cancer Institute developed LionVu, a web mapping tool to educate and inform community health professionals about the cancer burden in Pennsylvania and its catchment area of 28 counties in central Pennsylvania. LionVu, redesigned in 2023, uses several open-source JavaScript libraries (i.e., Leaflet, jQuery, Chroma, Geostats, DataTables, and ApexChart) to allow public health researchers the ability to map, download, and chart 21 publicly available datasets for clinical, educational, and epidemiological audiences. County and census tract data used in choropleth maps were all downloaded from the sources website and linked to Pennsylvania and catchment area county and census tract geographies, using a QGIS plugin and Leaflet JavaScript. Two LionVu demonstrations are presented, and 10 other public health related web-GIS applications are reviewed. LionVu fills a role in the public health community by allowing clinical, educational, and epidemiological audiences the ability to visualize and utilize health data at various levels of aggregation and geographical scales (i.e., county, or census tracts). Also, LionVu is a novel application that can translate and can be used, for mapping and graphing purposes. A dialog to demonstrate the potential value of web-based GIS to a wider audience, in the public health research community, is needed.
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Marcoux, Richard, Amadou Noumbissi und Tukufu Zuberi. „Orphans in Three Sahelian Countries: Exploratory Analyses from Census Data“. Canadian Studies in Population 37, Nr. 1-2 (31.12.2010): 245. http://dx.doi.org/10.25336/p65g71.
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Important investments in Africa have reduced slightly the levels child mortality but life expectancy still very low. The number of children without surviving biological parents is increasing and orphans are becoming an important social problem. Because Sahelian societies are mostly patriarchal, becoming fatherless or motherless will have different effects on the well being of the child. This paper examines the levels and trends of the survival status of the parents and then, living arrangements of orphans. We describe characteristics of these children with a special focus on education and economic activities. The paper uses the censuses from Chad, Niger and Senegal made available by the African Census Analysis Project (ACAP) held at University of Pennsylvania. These countries collected information on survival status of each biological parent to estimate adult mortality but the potential of this information for research on child well-being is rarely exploited.
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Nizeyimana, Egide, G. W. Petersen, M. C. Anderson, B. M. Evans, J. M. Hamlett und G. M. Baumer. „Statewide GIS/Census Data Assessment of Nitrogen Loadings from Septic Systems in Pennsylvania“. Journal of Environmental Quality 25, Nr. 2 (März 1996): 346–54. http://dx.doi.org/10.2134/jeq1996.00472425002500020020x.
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Marker, John T., und Konstadinos G. Goulias. „Truck Traffic Prediction Using Quick Response Freight Model Under Different Degrees of Geographic Resolution: Geographic Information System Application in Pennsylvania“. Transportation Research Record: Journal of the Transportation Research Board 1625, Nr. 1 (Januar 1998): 118–23. http://dx.doi.org/10.3141/1625-15.
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The new Quick Response Freight Manual (QRFM) was used to model truck traffic in Centre County, Pennsylvania, using Geographic Information System software. The QRFM methodology of truck traffic estimation follows the three-step process of trip generation, trip distribution, and traffic assignment. Trip generation was estimated by four classes of business employment and number of households and was aggregated to traffic analysis zones. Trip distribution employed a doubly constrained gravity model with travel time–based friction factors. User equilibrium was used for traffic assignment. Model calibration was performed by comaparing total vehicle miles traveled from model output with observed data. A comparison is made in truck traffic estimation between two models when the model resolution is changed, that is, when the size and number of traffic analysis zones (TAZs) is changed. One model uses census tracts and the other uses census blocks and block groups as TAZs. Both models use the same network, which includes all major highways and most local roads in the urbanized region of the county. Results from the two aggregation scales of analysis were compared with each other by using traffic counts in the Roadway Management System of Pennsylvania as reference data. The estimated truck traffic link volumes favor the use of the more disaggregate TAZ scheme, which is based on blocks and block groups.
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Remster, Brianna, und Rory Kramer. „SHIFTING POWER“. Du Bois Review: Social Science Research on Race 15, Nr. 02 (2018): 417–39. http://dx.doi.org/10.1017/s1742058x18000206.
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AbstractWhile prisoners cannot vote, they are counted as residents of the often rural legislative districts where they are incarcerated rather than their home districts. We examine the extent to which incarceration shifts the balance of a representative democracy by considering its impact on legislative apportionment. Drawing on data from the Census, Pennsylvania Department of Corrections, and Pennsylvania Redistricting Commission, we develop a counterfactual framework to examine whether removing and returning prisoners to their home districts affects equal representation. Because prisoners are disproportionately African American, we also employ this counterfactual to assess racial differences in the impact of prison gerrymandering. Findings indicate that incarceration shifts political power from urban districts to suburban and rural districts through legislative apportionment. Moreover, non-White communities suffer the most. We conclude by considering how our findings fit a growing literature on the role of mass incarceration in [re]producing racial inequalities in the contemporary United States.
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Sullivan, Michele. „African American Abolitionists in Chester County: Finding New Stories“. Pennsylvania History: A Journal of Mid-Atlantic Studies 90, Nr. 1 (2023): 48–28. http://dx.doi.org/10.5325/pennhistory.90.1.0048.
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ABSTRACT Historians have traditionally recounted the history of the Underground Railroad in Chester County and elsewhere in Pennsylvania as the work of heroic Quakers. When African Americans are included, for example, in R. C. Smedley’s History of the Underground Railroad in Chester and Neighboring Counties of Pennsylvania, they are nearly always mentioned only by their first names or have often been reduced to the role of “assistants.” Smedley overlooked the important function of free Black churches and residential communities. This article illuminates the stories of African American abolitionists in Chester County, including their part in assisting fugitives escape and the various forms of resistance in which they engaged. Utilizing original documents, letters, archival records, census data, newspapers, and the perspectives of recent historians, this article provides a frame and a context by which to understand the contributions of local Blacks to the larger story of abolition and the Underground Railroad.
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Schwartz, B. S., Jonathan Pollak, Melissa N. Poulsen, Karen Bandeen-Roche, Katherine Moon, Joseph DeWalle, Karen Siegel, Carla Mercado, Giuseppina Imperatore und Annemarie G. Hirsch. „Association of community types and features in a case–control analysis of new onset type 2 diabetes across a diverse geography in Pennsylvania“. BMJ Open 11, Nr. 1 (Januar 2021): e043528. http://dx.doi.org/10.1136/bmjopen-2020-043528.
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ObjectivesTo evaluate associations of community types and features with new onset type 2 diabetes in diverse communities. Understanding the location and scale of geographic disparities can lead to community-level interventions.DesignNested case–control study within the open dynamic cohort of health system patients.SettingLarge, integrated health system in 37 counties in central and northeastern Pennsylvania, USA.Participants and analysisWe used electronic health records to identify persons with new-onset type 2 diabetes from 2008 to 2016 (n=15 888). Persons with diabetes were age, sex and year matched (1:5) to persons without diabetes (n=79 435). We used generalised estimating equations to control for individual-level confounding variables, accounting for clustering of persons within communities. Communities were defined as (1) townships, boroughs and city census tracts; (2) urbanised area (large metro), urban cluster (small cities and towns) and rural; (3) combination of the first two; and (4) county. Community socioeconomic deprivation and greenness were evaluated alone and in models stratified by community types.ResultsBorough and city census tract residence (vs townships) were associated (OR (95% CI)) with higher odds of type 2 diabetes (1.10 (1.04 to 1.16) and 1.34 (1.25 to 1.44), respectively). Urbanised areas (vs rural) also had increased odds of type 2 diabetes (1.14 (1.08 to 1.21)). In the combined definition, the strongest associations (vs townships in rural areas) were city census tracts in urban clusters (1.41 (1.22 to 1.62)) and city census tracts in urbanised areas (1.33 (1.22 to 1.45)). Higher community socioeconomic deprivation and lower greenness were each associated with increased odds.ConclusionsUrban residence was associated with higher odds of type 2 diabetes than for other areas. Higher community socioeconomic deprivation in city census tracts and lower greenness in all community types were also associated with type 2 diabetes.
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Ortiz, Angel G., Daniel Wiese, Kristen A. Sorice, Minhhuyen Nguyen, Evelyn T. González, Kevin A. Henry und Shannon M. Lynch. „Liver Cancer Incidence and Area-Level Geographic Disparities in Pennsylvania—A Geo-Additive Approach“. International Journal of Environmental Research and Public Health 17, Nr. 20 (16.10.2020): 7526. http://dx.doi.org/10.3390/ijerph17207526.
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Many neighborhood socioeconomic index measures (nSES) that capture neighborhood deprivation exist but the impact of measure selection on liver cancer (LC) geographic disparities remains unclear. We introduce a Bayesian geoadditive modeling approach to identify clusters in Pennsylvania (PA) with higher than expected LC incidence rates, adjusted for individual-level factors (age, sex, race, diagnosis year) and compared them to models with 7 different nSES index measures to elucidate the impact of nSES and measure selection on LC geospatial variation. LC cases diagnosed from 2007–2014 were obtained from the PA Cancer Registry and linked to nSES measures from U.S. census at the Census Tract (CT) level. Relative Risks (RR) were estimated for each CT, adjusted for individual-level factors (baseline model). Each nSES measure was added to the baseline model and changes in model fit, geographic disparity and state-wide RR ranges were compared. All 7 nSES measures were strongly associated with high risk clusters. Tract-level RR ranges and geographic disparity from the baseline model were attenuated after adjustment for nSES measures. Depending on the nSES measure selected, up to 60% of the LC burden could be explained, suggesting methodologic evaluations of multiple nSES measures may be warranted in future studies to inform LC prevention efforts.
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Schwartz, Brian S., Marynia Kolak, Jonathan S. Pollak, Melissa N. Poulsen, Karen Bandeen-Roche, Katherine A. Moon, Joseph DeWalle et al. „Associations of four indexes of social determinants of health and two community typologies with new onset type 2 diabetes across a diverse geography in Pennsylvania“. PLOS ONE 17, Nr. 9 (16.09.2022): e0274758. http://dx.doi.org/10.1371/journal.pone.0274758.
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Evaluation of geographic disparities in type 2 diabetes (T2D) onset requires multidimensional approaches at a relevant spatial scale to characterize community types and features that could influence this health outcome. Using Geisinger electronic health records (2008–2016), we conducted a nested case-control study of new onset T2D in a 37-county area of Pennsylvania. The study included 15,888 incident T2D cases and 79,435 controls without diabetes, frequency-matched 1:5 on age, sex, and year of diagnosis or encounter. We characterized patients’ residential census tracts by four dimensions of social determinants of health (SDOH) and into a 7-category SDOH census tract typology previously generated for the entire United States by dimension reduction techniques. Finally, because the SDOH census tract typology classified 83% of the study region’s census tracts into two heterogeneous categories, termed rural affordable-like and suburban affluent-like, to further delineate geographies relevant to T2D, we subdivided these two typology categories by administrative community types (U.S. Census Bureau minor civil divisions of township, borough, city). We used generalized estimating equations to examine associations of 1) four SDOH indexes, 2) SDOH census tract typology, and 3) modified typology, with odds of new onset T2D, controlling for individual-level confounding variables. Two SDOH dimensions, higher socioeconomic advantage and higher mobility (tracts with fewer seniors and disabled adults) were independently associated with lower odds of T2D. Compared to rural affordable-like as the reference group, residence in tracts categorized as extreme poverty (odds ratio [95% confidence interval] = 1.11 [1.02, 1.21]) or multilingual working (1.07 [1.03, 1.23]) were associated with higher odds of new onset T2D. Suburban affluent-like was associated with lower odds of T2D (0.92 [0.87, 0.97]). With the modified typology, the strongest association (1.37 [1.15, 1.63]) was observed in cities in the suburban affluent-like category (vs. rural affordable-like–township), followed by cities in the rural affordable-like category (1.20 [1.05, 1.36]). We conclude that in evaluating geographic disparities in T2D onset, it is beneficial to conduct simultaneous evaluation of SDOH in multiple dimensions. Associations with the modified typology showed the importance of incorporating governmentally, behaviorally, and experientially relevant community definitions when evaluating geographic health disparities.
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Zubyk, Andrii. „Modern Ukrainian diaspora in Canada and the USA“. Visnyk of the Lviv University. Series Geography, Nr. 52 (27.06.2018): 110–23. http://dx.doi.org/10.30970/vgg.2018.52.10175.
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The current state of the Ukrainian diaspora, which is living in Canada and the United States, is analysed in this article. The Ukrainian diaspora in these countries has more than a century history. It is the second (Canada) and the third (USA), after the Russian Federation in the world by the number of Ukrainians. More than a third of the total number of Ukrainians outside of our country is overall living in Canada and the United States. The results of the census conducted in these countries, including their ethnocultural component, ethnicity, country of origin, native language and the language usually spoken at home were information basis of the study. In accordance with the results of the census, which reflect the resettlement and ethnolinguistic conformity of the Ukrainian diaspora, the author maps in the environment of program ArcMap are created. The Ukrainian diaspora resettlement in terms of provinces (Canada) and states (the USA) is analysed in the article. As a result of the late XX–early XXI century census, changes in its settlement is also revealed. It was found that Canadian Ukrainian diaspora lives mainly in the provinces, where Ukrainian emigration had begun. In the US, with the appearance of the fourth “wave” of Ukrainian emigration its resettlement has changed: unlike the early twentieth century when Ukrainians mostly arrived in Pennsylvania, New York and Ohio at present Ukrainians prefer emigration to the states of Washington, Oregon and California. The study found that the Ukrainian diaspora in these countries, despite the preservation of their ethnic origin, undergo significant linguistic assimilation. According to census found that in Canada and the USA minor ethnolinguistic conformity of the Ukrainian diaspora. The territorial regularity in ethnolinguistic conformity of Ukrainian diaspora: the smaller in number Ukrainian diaspora, the higher ethnolinguistic conformity are traced. Key words: Ukrainian diaspora, assimilation, entho-linguistic conformity, immigration, settlement, native language.
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Agnew, John, und Michael Shin. „The Counties that Counted: Could 2020 Repeat 2016 in the US Electoral College?“ Forum 17, Nr. 4 (05.03.2020): 675–92. http://dx.doi.org/10.1515/for-2019-0040.
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AbstractWe briefly trace the claim that a set of counties across the three states of Michigan, Pennsylvania, and Wisconsin in large part determined the outcome of the 2016 presidential election. Rather than the demographic characteristics of the Census as such it is the meaning that these categories (young/old, Black/White, male/female, and so on) take on in particular places in which people’s lives are grounded that drives electoral outcomes. Given that the counties in question were ones in which Obama had performed well but which Trump won in 2016 and this shift was put down to his appeal to those “left behind” in the post-2008 economy, we focus on whether or not this localized appeal can be expected to continue in 2020.
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SAMBROOK, ROGER C., und RICHARD F. VOSS. „FRACTAL ANALYSIS OF US SETTLEMENT PATTERNS“. Fractals 09, Nr. 03 (September 2001): 241–50. http://dx.doi.org/10.1142/s0218348x01000749.
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Estimates of fractal mass dimension D are used to characterize the spatial distribution or clustering behavior of human settlements in Pennsylvania, Kansas and Utah. Uniform random and rectangular lattice models are then compared to actual settlement patterns using mass dimension as a quantitative measure of model validity. Data was taken from a United States Geographical Survey geo-coded census database. The distribution of pairwise distances between settlements is used to estimate fractal dimension D in the scaling range from 3 to 300 km. Novel analysis methods are shown to reduce small and large scale distortions and increase the range of scaling behaviors for estimating mass dimension. Results show that the settlement patterns have mass dimensions which vary systematically with the visual impression of clustering visible in maps of these regions: Kansas D = 1.9, Pennsylvania D = 1.7, Utah D = 1.4, Uniform Random and Rectangular Lattice D = 2. The results demonstrate the utility of mass dimension when used to compare patterns in areas of different size and with differing numbers of settlements. Such comparisons are often impossible using traditional statistical methods. We also demonstrate how neither model captures the clustering behavior of actual settlement patterns, and propose that a measure of mass dimension might prove useful in validating future models of settlement behavior.
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Mar, Krista, Yawei Song, Khaldoun Hamade, Maria Katerina Alfaro, Alex Wrem, Christopher McNair und Amy Leader. „Abstract A017: Identifying priority neighborhoods for mobile cancer screening using georeferenced data“. Cancer Epidemiology, Biomarkers & Prevention 32, Nr. 1_Supplement (01.01.2023): A017. http://dx.doi.org/10.1158/1538-7755.disp22-a017.
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Abstract Background: Mobile screening units (MSUs) are an evidence-based approach known to reduce barriers and increase access to preventive services such as cancer screening. Less is known about how to plan and prioritize where MSUs are deployed to maximize impact and reduce the burden of disease. We used a geographic-based approach to create an index to identify which census tracts were of greatest priority for cancer screening, thereby creating a priority scoring metric for deploying the MSU across our 7-county cancer center catchment area. Methods: We assessed publicly available data reported at the census tract level for cancer relevance, choosing those data that were most likely to be associated with disparities in cancer screening or outcomes. This included data from the Social Vulnerability Index (socioeconomic status, percent of residents without health insurance, percent of residents reporting minority race or ethnicity, percent renting their housing, and percent with no transportation) as well as data from the Centers for Disease Control and Prevention (CDC) Places on the percent screened for breast cancer, cervical cancer, and colon cancer. Data was transformed from CDC Places to be percentage in need of breast cancer, cervical cancer, and colon screening rather than percentage screened. To construct the index, each of the variables was ranked from highest to lowest across all census tracts in Pennsylvania and New Jersey with a non-zero population (n=1,184). A percentile rank was then calculated for each census tract over each of these variables. Finally, an overall percentile rank for each tract was calculated. Index scores could range from 0.000000 (low priority for cancer screening) to 1.000000 (high priority for cancer screening). Results: There are 1,184 census tracts within our cancer center catchment area. Gloucester County NJ has the fewest census tracts (n=63) while Philadelphia County PA has the most census tracts (n=384). The mean index score across all census tracts was 0.400593 (SD = .198556) with a range of 0.000000 to 0.938343. Philadelphia County had the highest mean index score (0.400953) while Bucks County PA had the lowest mean index score (0.281576). In Philadelphia County, 76% of census tracts are above the mean index score, indicating high need for cancer screening, while in Bucks County, only 22% of census tracts are above the mean index score. A catchment area map by census tract visualizes the index score across the counties. Conclusion: A cancer screening index for census tracts in a cancer center catchment area can be used to prioritize resources such as a MSU in an evidenced-based manner. Next steps involve validating the index score against cancer disparities data in our catchment area and creating disease specific index scores to use with cancer specific screening initiatives. Citation Format: Krista Mar, Yawei Song, Khaldoun Hamade, Maria Katerina Alfaro, Alex Wrem, Christopher McNair, Amy Leader. Identifying priority neighborhoods for mobile cancer screening using georeferenced data [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A017.
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Nandi, Arindam, Sital Kalantry und Brian Citro. „Sex-selective Abortion Bans are Not Associated with Changes in Sex Ratios at Birth among Asian Populations in Illinois and Pennsylvania“. Forum for Health Economics and Policy 18, Nr. 1 (01.01.2015): 41–64. http://dx.doi.org/10.1515/fhep-2014-0018.
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Abstract Legal prohibitions on sex-selective abortions are proliferating in the United States. Eight state legislatures have banned abortions sought on the basis of the sex of the fetus, 21 states have considered such laws since 2009, and a similar bill is pending in U.S. Congress. These laws have been introduced and enacted without any empirical data about their impact or effectiveness. Prior studies of U.S. Census data found sex ratios among foreign-born Chinese, Korean and Indian immigrants were skewed in favor of boys, but only in families where there were already one or two girls. Using the variation in the timing of bans in Illinois and Pennsylvania as natural experiments, we compare the pre-ban and post-ban sex ratios of certain Asian newborn children in these states over 12-year periods. We then compare these ratios with the sex ratios of Asian newborn children in neighboring states during the same period. We find that the bans in Illinois and Pennsylvania are not associated with any changes in sex ratios at birth among Asians. In Illinois and its neighboring states, the sex ratio at birth of Asian children was not male-biased during our study period. On the other hand, the sex ratio at birth among Asians in Pennsylvania and its neighboring states was skewed slightly in favor of boys, but the enactment of the ban did not normalize the sex ratio. This strongly suggests that sex-selective abortion bans have had no impact on the practice of sex selection, to the extent that it occurs, in these states. This finding is highly relevant to legislative and policy debates in the U.S. Congress and state legislatures where sex-selective abortion laws are being considered.
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Schinasi, Leah H., Joan Rosen Bloch, Steven Melly, Yuzhe Zhao, Kari Moore und Anneclaire J. De Roos. „High Ambient Temperature and Infant Mortality in Philadelphia, Pennsylvania: A Case–Crossover Study“. American Journal of Public Health 110, Nr. 2 (Februar 2020): 189–95. http://dx.doi.org/10.2105/ajph.2019.305442.
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Objective. To quantify the association between heat and infant mortality and identify factors that influence infant vulnerability to heat. Methods. We conducted a time-stratified case–crossover analysis of associations between ambient temperature and infant mortality in Philadelphia, Pennsylvania, during the warm months of 2000 through 2015. We used conditional logistic regression models to estimate associations of infant mortality with daily temperatures on the day of death (lag 0) and for averaging periods of 0 to 1 to 0 to 3 days before the day of death. We explored modification of associations by individual and census tract–level characteristics and by amounts of green space. Results. Risk of infant mortality increased by 22.4% (95% confidence interval [CI] = 5.0%, 42.6%) for every 1°C increase in minimum daily temperature over 23.9°C on the day of death. We observed limited evidence of effect modification across strata of the covariates. Conclusions. Our results contribute to a growing body of evidence that infants are a subpopulation that is particularly vulnerable to climate change effects. Further research using large data sets is critically needed to elucidate modifiable factors that may protect infants against heat vulnerability.
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Seedor, Rino S., Daniel T. Vader, Renee H. Moore, Alexandre J. Motta, Sara E. Lally, Carol L. Shields, Takami Sato und Marlana M. Orloff. „Geospatial analysis of the distribution of uveal melanoma patients at a referral center in the United States.“ Journal of Clinical Oncology 42, Nr. 16_suppl (01.06.2024): e21566-e21566. http://dx.doi.org/10.1200/jco.2024.42.16_suppl.e21566.
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e21566 Background: Approximately 2500 new uveal melanoma (UM) cases (5.2 cases per million population) are diagnosed yearly in the United States. We previously identified three unique geospatial accumulations of UM in North Carolina, Alabama, and New York based on our clinical experience. Such unexpected findings prompted us to conduct a more systematic evaluation of geospatial accumulations of UM patients at our institution. Methods: Through the electronic medical record system, we identified patients seen at our institution with a diagnosis of UM. Identified living patients and family of deceased patients were either sent an e-mail or paper letter with an internet link to a survey. The survey asked for the patient’s name, date of birth, sex, date of primary UM diagnosis, address at time of UM diagnosis and number of years at that address, and all previous addresses and dates of residence prior to the UM diagnosis. Using these addresses, ArcGIS and R software was used to analyze the geospatial distribution of our UM patients. The data was supplemented with 2020 American Community Survey census estimates at the state, county, and census tract level to estimate population-based rates of UM. Results: We identified 2718 UM patients in our clinical database, and a total of 726 participants completed the survey with a total of 2939 US addresses. The majority of addresses were precise to the street address level (77.9%). At the time of UM diagnosis, patients had lived at their current address for a median of 16 years. Pennsylvania and the neighboring states expectedly made up the majority (63.6%) of our patients, but about 1/3 of our patients resided in other states at the time of their UM diagnosis (total of 42 different states). Several counties presented elevated rates of UM with ≥5 case per 100,000 persons. We observed a group of counties in central Pennsylvania, at the border of Pennsylvania and New York, and in upper New York by the Finger Lakes with notably elevated rates of UM, which was consistent with our clinical observations at our institution. Several neighboring counties in Kentucky and Virginia also presented elevated rates. Conclusions: Through this pilot project, we have demonstrated that it is possible to collect lifetime residency information from UM patients in order to map their geospatial distribution in the US. Furthermore, although institutional bias toward referring physicians should be considered, our geospatial analysis identified accumulations of UM in areas similar to our clinical concerns. The results of our study warrant further investigations into environmental influences on UM development. Our future goal is to extend our approach through national and international collaborations to increase the number of participants in the analysis and to minimize institutional bias.
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Harmon, Joey, Melissa C. Endy, Michael A. Sulzinski und Brian J. Piper. „Changes in COVID-19 Vaccine Hesitancy within Pennsylvania over the Course of the Pandemic“. Guthrie Journal 75, Nr. 2 (05.01.2023): 62–72. http://dx.doi.org/10.3138/guthrie-2023-0005.
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Background: The global COVID-19 pandemic highlighted vaccination concerns in Pennsylvania. Limited information on vaccine hesitancy in the state prompted this study, which aimed to characterize demographic determinants of changes in hesitancy since the COVID-19 vaccine's availability. Methods: The US Census Bureau's Household Pulse Survey (N = 62,826) provided vaccine hesitancy/status data from January 2021 to April 2022. Specifically surveys from January 2021, June 2021, and April 2022 were utilized. Demographics (race, age, education status, household income, and sex at birth) were compared using odds ratios (ORs) and CI. Results: Significant changes in vaccine hesitancy occurred among certain populations. Initially, odds of vaccination for African Americans were lower (OR 0.683) compared to Whites, but in the latest survey, the odds were higher (OR 1.443). Asians consistently had the highest odds (OR 9.009) of vaccination. In January 2021, odds of vaccination among men were lower (OR 0.856) than women, but later, the odds increased (OR 1.402). Patterns in household income, age, and education status groups remained consistent. Those aged 65 years and over, with a household annual income of more than $150,000, or a bachelor's degree or higher had the highest vaccination rates. Conclusion: Findings indicate stable vaccination patterns among non-race demographic categories during the pandemic. However, the relationship between vaccination status and race was more dynamic. Further qualitative investigations are needed to understand these changes and address inaccurate beliefs surrounding COVID-19 vaccination in Pennsylvania.
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Donohoe, Joseph, Vince Marshall, Xi Tan, Fabian T. Camacho, Roger T. Anderson und Rajesh Balkrishnan. „Spatial Access to Primary Care Providers in Appalachia“. Journal of Primary Care & Community Health 7, Nr. 3 (23.02.2016): 149–58. http://dx.doi.org/10.1177/2150131916632554.
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Purpose: The goal of this research was to examine spatial access to primary care physicians in Appalachia using both traditional access measures and the 2-step floating catchment area (2SFCA) method. Spatial access to care was compared between urban and rural regions of Appalachia. Methods: The study region included Appalachia counties of Pennsylvania, Ohio, Kentucky, and North Carolina. Primary care physicians during 2008 and total census block group populations were geocoded into GIS software. Ratios of county physicians to population, driving time to nearest primary care physician, and various 2SFCA approaches were compared. Results: Urban areas of the study region had shorter travel times to their closest primary care physician. Provider to population ratios produced results that varied widely from one county to another because of strict geographic boundaries. The 2SFCA method produced varied results depending on the distance decay weight and variable catchment size techniques chose. 2SFCA scores showed greater access to care in urban areas of Pennsylvania, Ohio, and North Carolina. Conclusion: The different parameters of the 2SFCA method—distance decay weights and variable catchment sizes—have a large impact on the resulting spatial access to primary care scores. The findings of this study suggest that using a relative 2SFCA approach, the spatial access ratio method, when detailed patient travel data are unavailable. The 2SFCA method shows promise for measuring access to care in Appalachia, but more research on patient travel preferences is needed to inform implementation.
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Razzaghi Asl, Sina. „To What Extent Have Nature-Based Solutions Mitigated Flood Loss at a Regional Scale in the Philadelphia Metropolitan Area?“ Urban Science 7, Nr. 4 (04.12.2023): 122. http://dx.doi.org/10.3390/urbansci7040122.
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Globally, floods are becoming more severe, lasting longer, and occurring more frequently because of changes in climate, rapid urbanization, and changing human demographics. Although traditional structural flood mitigation infrastructures (e.g., drainage systems, levees) are effective in urban areas, their functionalities in the face of extreme rainfall events and increased development largely depend on the capacity and location of such systems, making complementary solutions such as nature-based solutions (NBS) important. The concept of NBS within the context of flood mitigation has gained traction in the last decade; however, the success of NBS depends on their effectiveness and distribution over urban regions. This article seeks to examine the potential of NBS as a flood loss mitigation tool in one of the fastest-growing and flood-prone counties of Pennsylvania, Montgomery County, using Generalized Linear Model (GLR) and Geographically Weighted Regression (GWR) techniques. The analysis integrates the National Risk Index dataset for river flooding, a 100-year flood zone layer from National Flood Hazard Layer (NFHL) provided by FEMA, with land use and impervious surface percent data derived from National Land Cover Database (NLCD) for 2019 and socioeconomic data at the U.S. census tract level from the 2019 U.S. Census. This study’s findings partially contradict previous research by revealing an unexpected relationship between NBS quantity in floodplains and expected annual loss. Findings also suggest that small size and disconnected patches of NBS in floodplains in some dense urban areas effectively reduce total losses from flood events.
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Simpson, Elizabeth, Edward Miller, Molly Wylie und Marc Cohen. „Providing Nursing Home Care in an Era of Increasing Scarcity: The Case of Pennsylvania“. Innovation in Aging 5, Supplement_1 (01.12.2021): 501. http://dx.doi.org/10.1093/geroni/igab046.1935.
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Abstract Medicaid financing of nursing home (NH) care provides the strongest safety net for low income older adults, persons who have high-intensity long-term care (LTC) needs, and consumers with exorbitant LTC costs. Yet, NHs currently face serious threats to their financial viability, particularly in the context of the COVID-19 pandemic, where the costs of caring for residents in a safe way have increased significantly, even as the ability to recoup these costs from the Medicaid program has been constrained. The purpose of this study is to assess key demand and supply factors affecting the performance of the NH industry in Pennsylvania over time. It draws from several large, national data sources, including NH Compare, LTCFocus.org, the U.S. Bureaus of the Census and Labor Statistics, and Certification and Survey Provider Enhanced Reports, as well as state-level population projections and Departments of Health and Human Services data. An aggregate database was constructed with historical data points at the facility, regional, and state level. Annual total and regional trends were examined from 2010 to 2020. Findings suggest a growing gap between what NHs require to meet the needs of residents and the level of reimbursement paid by the largest funder: Medicaid. Considering demographic trends, this gap will only grow over time in the absence of policy change. The pandemic has further highlighted the existing challenges resulting from an underfunded service infrastructure and the need for additional investment if NHs are to provide high quality care to a growing cohort of older adults requiring support.
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Zeigler-Johnson, Charnita M., Ann Tierney, Timothy R. Rebbeck und Andrew Rundle. „Prostate Cancer Severity Associations with Neighborhood Deprivation“. Prostate Cancer 2011 (2011): 1–9. http://dx.doi.org/10.1155/2011/846263.
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Background. The goal of this paper was to examine neighborhood deprivation and prostate cancer severity.Methods. We studied African American and Caucasian prostate cancer cases from the Pennsylvania State Cancer Registry. Census tract-level variables and deprivation scores were examined in relation to diagnosis stage, grade, and tumor aggressiveness.Results. We observed associations of low SES with high Gleason score among African Americans residing in neighborhoods with low educational attainment (OR = 1.34, 95% CI = 1.13–1.60), high poverty (OR = 1.39, 95% CI = 1.15–1.67), low car ownership (OR = 1.46, 95% CI = 1.20–1.78), and higher percentage of residents on public assistance (OR = 1.32, 95% = 1.08–1.62). The highest quartile of neighborhood deprivation was also associated with high Gleason score. For both Caucasians and African Americans, the highest quartile of neighborhood deprivation was associated with high Gleason score at diagnosis (OR = 1.34, 95% CI = 1.19–1.52; OR = 1.71, 95% CI = 1.21–2.40, resp.).Conclusion. Using a neighborhood deprivation index, we observed associations between high-grade prostate cancer and neighborhood deprivation in Caucasians and African-Americans.
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Fyfe, David A., und Deryck W. Holdsworth. „Signatures of Commerce in Small-Town Hotel Guest Registers“. Social Science History 33, Nr. 1 (2009): 17–45. http://dx.doi.org/10.1017/s0145553200010890.
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Guest registers for six commercial hotels are analyzed to reveal everyday, nonmigratory travel patterns associated with small towns and villages in the upper Susquehanna valleys of New York and Pennsylvania at the turn of the twentieth century. The residences of guests are mapped using geographic information system (GIS) software and reveal two broad patterns of connectivity, a translocal cluster of visitors from places within the immediate vicinity and a set of visitors from more distant places up the urban system. Census and directory data identify many repeat visitors, such as hucksters and peddlers extending the reach of rural stores and merchants traveling circuits as agents of metropolitan manufacturing centers. In addition to commercial travelers, the presence of traveling entertainments, such as vaudeville acts and circuses, in hotel guest registers reveals shifts in American popular culture and entertainments on small-town Main Streets. These registers offer a fixed window onto a mobile world, and the signatures hint at the types of connections between these settlements and the outside world.
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Liu, Ann Y., Frank C. Curriero, Thomas A. Glass, Walter F. Stewart und Brian S. Schwartz. „Associations of the Burden of Coal Abandoned Mine Lands with Three Dimensions of Community Context in Pennsylvania“. ISRN Public Health 2012 (10.05.2012): 1–11. http://dx.doi.org/10.5402/2012/251201.
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Background. Pennsylvania, with thousands of abandoned coal mines and miles of streams polluted with acid mine drainage, has the largest domestic coal mining burden contributing to deterioration of communities. Objectives. To evaluate contextual aspects by examining associations between coal abandoned mine lands (AML) and community measures of socioeconomic deprivation, social disorganization, and physical disorder. Methods. AML exposure data from the Reclaimed Abandoned Mine Land Inventory System were used to create density, diversity, accessibility, and clustering metrics. The three community context outcome measures were comprised of 14 census variables. In community-level analyses, 10 AML variables were evaluated separately with each dimension of community context, adjusting for covariates, in communities with and without abandoned mines. Results. We observed consistent associations between higher AML burden and worse socioeconomic deprivation, negative relations with social disorganization, but no statistically significant associations with physical disorder. Six of 10 AML variables were associated with socioeconomic deprivation, many consistently exhibiting exposure-effect patterns of worse deprivation with greater AML. Conclusions. Higher AML was associated with higher socioeconomic deprivation. These results can help prioritize the use of Surface Mining Control and Reclamation Act funds and inform decisions regarding Marcellus shale drilling to prevent analogous environmental degradation and public health impacts.
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Jacoby, Sara F., Charles C. Branas, Daniel N. Holena und Elinore J. Kaufman. „Beyond survival: the broader consequences of prehospital transport by police for penetrating trauma“. Trauma Surgery & Acute Care Open 5, Nr. 1 (November 2020): e000541. http://dx.doi.org/10.1136/tsaco-2020-000541.
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BackgroundTime to definitive hemorrhage control is a primary driver of survival after penetrating injury. For these injuries, mortality outcomes after prehospital transport by police and emergency medical service (EMS) providers are comparable. In this study we identify patient and geographic predictors of police transport relative to EMS transport and describe perceptions of police transport elicited from key stakeholders.MethodsThis mixed methods study was conducted in Philadelphia, Pennsylvania, which has the highest rate of police transport nationally. Patient data were drawn from Pennsylvania’s trauma registry and geographic data from the US Census and American Community Survey. For all 7500 adults who presented to Philadelphia trauma centers with penetrating injuries, 2006–2015, we compared how individual and geospatial characteristics predicted the odds of police versus EMS transport. Concurrently, we conducted qualitative interviews with patients, police officers and trauma clinicians to describe their perceptions of police transport in practice.ResultsPatients who were Black (OR 1.50; 1.20–1.88) and Hispanic (OR 1.38; 1.05–1.82), injured by a firearm (OR 1.58; 1.19–2.10) and at night (OR 1.48; 1.30–1.69) and who presented with decreased levels of consciousness (OR 1.18; 1.02–1.37) had higher odds of police transport. Neighborhood characteristics predicting police transport included: percent of Black population (OR 1.18; 1.05–1.32), vacant housing (OR 1.40; 1.20–1.64) and fire stations (OR 1.32; 1.20–1.44). All stakeholders perceived speed as police transport’s primary advantage. For patients, disadvantages included pain and insecurity while in transport. Police identified occupational health risks. Clinicians identified occupational safety risks and the potential for police transport to complicate the workflow.ConclusionsPolice transport may improve prompt access to trauma care but should be implemented with consideration of the equity of access and broad stakeholder perspectives in efforts to improve outcomes, safety, and efficiency.Level of evidenceEpidemiological study, level III.
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Boukovalas, Stefanos, und Jack Sariego. „The Urban/Rural Dichotomy in the Distribution of Breast Cancer across Pennsylvania“. American Surgeon 81, Nr. 9 (September 2015): 884–88. http://dx.doi.org/10.1177/000313481508100922.
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Breast cancer rates clearly differ across the United States. This is due to a variety of factors, but at least one determinant is the population density. Breast cancer detection rates and treatment paradigms may differ in rural areas when compared with more urban ones. As the population becomes more mobile and diffuse, this may or may not be a worsening problem. The current analysis was undertaken to examine the breast cancer incidence and outcomes in a single state in an attempt to plan for resource allocation in the future. A retrospective analysis was performed using data available from the Pennsylvania Department of Health regarding breast cancer rates by county, the distribution of cases with regard to degree of rurality, death rates by county as a function of rurality, and the age distribution of all presenting cases. Data from 1999 were compared with those of 2009. The United States Census Bureau definition of rurality was used, which specifies that a county be classified as rural if the population density is less than 284 persons/square mile. Between 1999 and 2009, the population of Pennsylvania increased by approximately 3.4 per cent (421,325 people). The urban population increased by 3.9 per cent, whereas the rural population increased by only 2.2 per cent. During that same period, the number of cancer cases/100,000 population remained about the same: 391.41 in 1999; 390.7 in 2009. However, the distribution of cases shifted during that time toward more rural areas of the state: in 1999, there were 372.3 breast cancer cases/100,000 population compared with 2009 when the rate was 384.4/100,000 population. The number of cancer deaths/100,000 population actually dropped overall during the decade: 98.5 in 1999 versus 82.3 in 2009. Though this was true in both urban and rural counties, the decrease was much less pronounced in the rural areas. In urban counties, the death rate dropped from 100.5 to 81.5/100,000 population, whereas in rural counties, the drop was only from 93.3 to 84.3. The greater increase in cases diagnosed in rural areas of Pennsylvania is only partially explained by the relatively greater increase in rural population. There are undoubtedly other issues at work in rural areas: environmental factors, diffusion of resources, less access to surveillance programs. In addition, though the death rate has dropped in both rural and urban areas, this is much less pronounced in rural counties. Coupled with the increase in prevalence in those areas, this suggests that breast cancer care may be lagging in rural areas. There is a need to examine allocation of resources and surveillance programs.
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Killian, Larita. „The Continuing Problem of Special Districts in American Government“. Accounting and the Public Interest 11, Nr. 1 (01.07.2011): 52–67. http://dx.doi.org/10.2308/apin-10076.
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ABSTRACT Due to fiscal constraints and demands for increased accountability, scholars and public officials are reviewing the structure and reporting practices of local governments. These efforts are often incomplete, however, because they bypass special districts, which now comprise over 40 percent of all local governments. The proliferation of special districts has the potential to increase government costs, redirect the allocation of scarce resources, remove debt and expenditure practices from the public eye, and reduce democratic controls over elected officials. This paper highlights some of the public interest concerns related to these entities to inform future, localized research. For decades, scholars have approached special districts from two opposing theoretical perspectives: institutional reform and public choice. Literature from these opposing perspectives is used to analyze special districts along three dimensions: efficiency and economy of operations, policy alignment and allocation of resources, and democratic accountability. This paper uses the U.S. Census Bureau definition of special districts, though alternative definitions are discussed. Efforts by four states (Florida, Pennsylvania, Indiana, and New York) to improve local government, and their varying approaches to special districts, are reviewed, leading to the conclusion that the complex issues related to special districts must be resolved within state contexts.
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Weaver, Chris, David Fyfe, Anthony Robinson, Deryck Holdsworth, Donna Peuquet und Alan M. MacEachren. „Visual Exploration and Analysis of Historic Hotel Visits“. Information Visualization 6, Nr. 1 (01.02.2007): 89–103. http://dx.doi.org/10.1057/palgrave.ivs.9500145.
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Understanding the spatial and temporal characteristics of individual and group behavior in social networks is a critical component of visual tools for intelligence analysis, emergency management, consumer analysis, and human geography. Identification and analysis of patterns of recurring events is an essential feature of such tools. In this paper, we describe an interactive visual tool for exploring the visitation patterns of guests at two hotels in central Pennsylvania from 1894 to 1900. The centerpiece of the tool is a wrapping spreadsheet technique, called reruns, that reveals regular and irregular periodic patterns of events in multiple overlapping artificial and natural calendars. Implemented as a coordinated multiple view visualization in Improvise, the tool is in ongoing development through an iterative process of data collection, transcription, hypothesis, design, discovery, analysis, and evaluation in close collaboration with historical geographers. Numerous discoveries have driven additional data collection from archival newspaper and census sources, as well as plans to enhance analysis of spatial patterns using historic weather records and railroad schedules. Distributed online evaluations of usability and usefulness have resulted in feature and design recommendations that are being incorporated into the tool.
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Gibbons, Joseph, Michael S. Barton und Timothy T. Reling. „Do gentrifying neighbourhoods have less community? Evidence from Philadelphia“. Urban Studies 57, Nr. 6 (19.03.2019): 1143–63. http://dx.doi.org/10.1177/0042098019829331.
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One of the more detrimental effects of gentrification is the potential for a decreased sense of neighbourhood community. Systematic analysis of the effect of gentrification on communities has been limited. This study investigated how an individual’s sense of connection to neighbourhood community, as measured by trust, belongingness and sense of cooperation, was influenced by their residence in a gentrifying neighbourhood. We utilised hierarchical linear models with individual data from the 2014/2015 Public Health Management Corporation’s Southeastern Pennsylvania Household Health Survey and neighbourhood data from the 2000 Decennial Census and 2010–2014 American Community Survey. We find that gentrification overall has a negative relation with neighbourhood community, but this relationship varied by the racial/ethnic turnover underlying the changes taking place in these neighbourhoods. Specifically, we find that gentrification marked by increases in Whites and decreases in non-Whites had no measurable relation with neighbourhood community; that gentrification marked by increases in non-Whites alone had a positive effect on neighbourhood community for Black and Hispanic residents; and that gentrifying neighbourhoods which experienced an increase in both Whites and non-Whites had a negative overall relation with neighbourhood community.
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Park, Mia G., Neelendra K. Joshi, Edwin G. Rajotte, David J. Biddinger, John E. Losey und Bryan N. Danforth. „Apple grower pollination practices and perceptions of alternative pollinators in New York and Pennsylvania“. Renewable Agriculture and Food Systems 35, Nr. 1 (25.04.2018): 1–14. http://dx.doi.org/10.1017/s1742170518000145.
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AbstractPollinator declines coupled with increasing demand for insect pollinated crops have the potential to cause future pollinator shortages for our most nutritious and valuable crops. Ensuring adequate crop pollination may necessitate a shift in pollination management, from one that primarily relies on the managed European honeybee (Apis melliferaL.) to one that integrates alternative pollinators. While a growing body of scientific evidence supports significant contributions made by naturally occurring, native bees for crop pollination, translating research to practice requires buy-in from growers. The intention of agricultural extension is to address grower needs and concerns; however, few studies have assessed grower knowledge, perceptions and attitudes about native pollinators. Here we present findings from questionnaire-based surveys of over 600 apple growers in New York State and Pennsylvania, coupled with ecological data from bee surveys. This hybrid sociological and biological survey allows us to compare grower knowledge and perceptions to an actual pollinator census. While up to 93% of respondents highly valued importance of native bees, 20% growersdid not knowhow much native bees actually contribute to their orchard pollination. Despite the uncertainty, a majority of growers were open to relying on native bees (up to 60% in NY and 67% in PA) and to making low-cost changes to their farm's management that would benefit native pollinators (up to 68 in NY and 85% in PA). Growers consistently underestimated bee diversity, but their estimates corresponded to major bee groups identifiable by lay persons, indicating accurate local knowledge about native bees. Grower reliance on honeybees increased with farm size; because native bee abundance did not measurably decrease with farm size, renting honeybees may be motivated by risk avoidance rather than grower perception of lower native bee activity. Demonstrated effectiveness of native pollinators and clear guidelines for their management were the most important factors influencing grower decision to actively manage orchards for native bees. Our results highlight a pressing need for an active and research-based extension program to support diversification of pollination strategies in the region.
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Lynch, Shannon M., Yinuo Yin und Elizabeth Handorf. „Abstract A03: Applying machine learning approaches to social environmental data from the U.S. Census in cancer studies: Challenges and considerations“. Cancer Epidemiology, Biomarkers & Prevention 29, Nr. 9_Supplement (01.09.2020): A03. http://dx.doi.org/10.1158/1538-7755.modpop19-a03.
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Abstract Background: The precision medicine initiative calls for the study of genes, behaviors, and environment to improve disease prevention. There is a growing body of research supporting the role of social environment (i.e., the neighborhood in which one lives) in cancer health disparities. However, recent efforts have focused on applying empiric, high-dimensional computing approaches to genetic data, with less of an emphasis on environment. In this study, we adapted and applied empiric machine learning approaches to identify which method would be most effective at evaluating the effects of social environment on advanced prostate cancer in a simulated dataset. As is common in high-dimensional data, we encountered (and will present) statistical challenges that arose during analysis, specifically related to multicollinearity. Methods: Pennsylvania Prostate Cancer Registry data from 1995-2005 were linked to publicly available social environmental data from the 2000 U.S. Census via a geocode at the census tract level using ArcGIS software. This primary data consisted of 86,629 prostate cancer cases and 14,663 census variables. U.S. Census variables, which are defined in terms of neighborhood socioeconomic variables, such as education, income, employment, etc., are known to be highly correlated. A simulated dataset was created using the data structure of our primary dataset, where a set of 10 prespecified variables were independent predictors of a binary outcome, and the remaining 990 variables had no effect. Test and training sets were created and various machine learning approaches were applied and compared: standard regression models (REG), Lasso penalized regression (LASSO), elastic net regression (ELNET), and random forest (RF). The most successful method at identifying “true” variables (or highly correlated surrogates), limiting false-positive results, and consistently replicating findings was considered the most effective approach. Simulations were repeated 500 times, and results summarized. Results: Over the 500 simulations, the methods identified 6.3 (REG), 6.4 (LASSO), 8.2 (ELNET), and 10 (RF) of the 10 true (or highly correlated surrogate) variables. In addition, 38.8 (REG), 13.3 (LASSO), 49.9 (ELNET), and 65 (RF) false positive variables were identified. RF consistently replicated the selection of all 10 variables across simulations 100% of the time, whereas LASSO was consistently unable to identify 2 of the 10 true variables. Conclusions: Preliminary findings suggest a combination of RF and LASSO may be the most effective approach; LASSO has the best overall ability to identify true variables while avoiding false positives; RF identifies true variables consistently. Given that Lasso was unable to detect 2 of the true variables, we will also present findings from multivariate models to allow for adjustment due to residual confounding. Final results should be tested in a real data setting where additional considerations for multicollinearity would need to be explored. Citation Format: Shannon. M Lynch, Yinuo Yin, Elizabeth Handorf. Applying machine learning approaches to social environmental data from the U.S. Census in cancer studies: Challenges and considerations [abstract]. In: Proceedings of the AACR Special Conference on Modernizing Population Sciences in the Digital Age; 2019 Feb 19-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(9 Suppl):Abstract nr A03.
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Begum, Thoin F., Ellen Kim, Lin Zhu, Yin Tan, Evelyn T. González, Marilyn A. Fraser, Yingzhang Lin et al. „Abstract A040: Examining the geographical distribution of a colorectal cancer awareness community outreach program“. Cancer Epidemiology, Biomarkers & Prevention 32, Nr. 12_Supplement (01.12.2023): A040. http://dx.doi.org/10.1158/1538-7755.disp23-a040.
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Abstract Background: Colorectal cancer (CRC) is a significant health issue in the United States, ranking as the third most diagnosed cancer and the second leading cause of cancer-related deaths. The incidence of CRC varies across the east coast of the United States due to multiple factors, including disparities in lifestyle, healthcare accessibility, and environmental exposures. Community-based participatory research plays a vital role in identifying effective interventions to enhance awareness of cancer risk and prevention in specific communities. Methods: This study focused on Asian Americans, Blacks, and Hispanics residing in the Greater Philadelphia (PA), New Jersey (NJ), and New York City (NYC) areas. The Synergistic Partnership for Enhancing Equity in Cancer Health (SPEECH) collaborated with community-based organizations' leaders and staff to streamline recruitment, workshop delivery, and survey data collection. The workshop curriculum covered essential CRC information, including facts, dietary habits, and screening guidelines. Pre- and post-workshop surveys were used to assess changes in CRC knowledge and screening intention. The distribution of participants was analyzed using Arc GIS. Results: [GXM1] The study population consisted of 212 Asian, 172 Hispanic/Latino, and 126 African American/Black participants. Geographical data was obtainable for 486 participants, primarily from New York (n=286, 58.8%), Pennsylvania (n=150, 30.9%), and New Jersey (n=49, 10.1%). These states form the Pennsylvania, New Jersey, and New York City (PNN) region, which is known for its high concentrations of neighborhoods experiencing persistent poverty, especially in areas densely populated by minorities. Distinct examples include neighborhoods within the Bronx borough of New York City and Philadelphia County in Pennsylvania. Alarmingly, in some counties within the PNN region, as many as 26% of the census tracts are categorized as persistently impoverished. This pattern of concentrated poverty is supported by several existing studies and research reports. Conclusions: The distribution of participants aligned with the study area of SPEECH and areas characterized by persistent poverty. These findings provide valuable insights to guide efforts in improving cancer health equity in the identified regions. Citation Format: Thoin F. Begum, Ellen Kim, Lin Zhu, Yin Tan, Evelyn T. González, Marilyn A. Fraser, Yingzhang Lin, Nathaly Rubio-Torio, Tenya Blackwell, Carolyn Martin, Safa Ibrahim, Ming-Chin Yeh, Grace X. Ma. Examining the geographical distribution of a colorectal cancer awareness community outreach program [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A040.
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Muluk, Sruthi, Coleman Drake, Zhaojun Sun, Manisha Bhattacharya, Bruce Jacobs und Lindsay M. Sabik. „Abstract A137: Drive time to physicians and outcomes for bladder cancer“. Cancer Epidemiology, Biomarkers & Prevention 32, Nr. 12_Supplement (01.12.2023): A137. http://dx.doi.org/10.1158/1538-7755.disp23-a137.
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Abstract Introduction: Poor geographic access to cancer care providers can delay treatment and limit access to high quality care. Previous research has shown that for patients with bladder cancer, time to cystectomy and receipt of neoadjuvant chemotherapy are associated with improved survival. Travel burden may be an important barrier to timely guideline-concordant treatment and is particularly relevant for residents of rural areas, which are often medically underserved. This study examines the association between drive time to medical oncologists and urologists and clinical outcomes for muscle-invasive bladder cancer (MIBC) patients. Data and Methods: We used information on physician location from the Centers for Medicare and Medicaid Services and patient-level data from the 2010-2016 Pennsylvania Cancer Registry linked to Pennsylvania Healthcare Cost Containment Council (PHC4) inpatient discharge data through 2018. We examined patients in Pennsylvania with a first lifetime bladder cancer diagnosis who underwent radical cystectomy at a non-federal short-term general hospital identified in PHC4. Outcomes examined were surgery within 90 days, receipt of neoadjuvant chemotherapy, 90-day mortality and 90-day readmission. We estimated multivariable linear regression models at the patient level. Our primary exposures were the natural log number of minutes from the patient’s home census tract centroid to the nearest medical oncologist and the nearest urologist. We controlled for patient age, sex, race/ethnicity, tumor size, tumor node involvement, and Elixhauser comorbidity index. We included a control for whether the patient received neoadjuvant chemotherapy in models estimating the association between drive times and cystectomy within 90 days. We also controlled for area-level characteristics, including ZIP code median and area deprivation index quartile. Standard errors were clustered at the county level.Results: The study included 954 patients with MIBC, 1,520 medical oncologists, and 976 urologists in Pennsylvania. Mean (SD) drive time to the nearest oncologist was 17.1 (11.4) minutes and median drive time was 14.4 minutes. Mean drive time to the nearest urologist was 13.9 (9.2) minutes and median drive time was 11.7 minutes. A 30-minute increase in drive time to the nearest urologist was associated with a 12.5 percentage point lower likelihood of undergoing cystectomy within 90 days (95% CI: -24.3 to -0.6). A 30-minute increase in drive time to the nearest oncologist was associated with an 11.9 percentage point lower likelihood of receiving neoadjuvant chemotherapy (95% CI: -23.4 to -0.4). Drive time was not significantly associated with 90-day mortality or readmission within 90 days. Conclusions: Drive time to both oncologists and urologists is associated with timely receipt of guideline-recommended care for patients with MIBC. Understanding the impact of geographic access to medical oncologists and urologists on clinical outcomes for patients with MIBC can inform providers and policymakers in addressing geographic equity in cancer care. Citation Format: Sruthi Muluk, Coleman Drake, Zhaojun Sun, Manisha Bhattacharya, Bruce Jacobs, Lindsay M. Sabik. Drive time to physicians and outcomes for bladder cancer [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A137.
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Watson, Megan, David Grande, Archana Radhakrishnan, Nandita Mitra, Katelyn R. Ward und Craig Evan Pollack. „Racial Differences in Prostate Cancer Treatment: The Role of Socioeconomic Status“. Ethnicity & Disease 27, Nr. 3 (20.07.2017): 201. http://dx.doi.org/10.18865/ed.27.3.201.
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<p><strong>Objective: </strong>This study examines whether socioeconomic status (SES), measured at both the individual and neighborhood levels, is associated with receipt of definitive treatment for localized prostate cancer and whether these associations mediate racial differences in treatment between non-Hispanic White and non-Hispanic Black men. </p><p><strong>Design: </strong>The Philadelphia Area Prostate Cancer Access Study (P2 Access) is a mailed, cross-sectional survey of men sampled from the Pennsylvania Cancer Registry, combined with neighborhood Census data. </p><p><strong>Setting: </strong>Eight counties in southeastern Pennsylvania. </p><p><strong>Participants: </strong>2,386 men with prostate adenocarcinoma. </p><p><strong>Main Measures: </strong>Receipt of definitive treatment, race, self-reported income, education, employment status, and neighborhood SES. </p><p><strong>Results: </strong>Overall, Black and White men were equally likely to receive definitive treatment. Men living in neighborhoods with higher SES were more likely to receive definitive treatment (OR 1.57, 95%CI 1.01, 2.42). Among men who received definitive treatment, Black men were significantly less likely to receive radical prostatectomy compared with White men (OR .71, 95% CI .52, .98), as were men with some college education compared with those with a high school education or less (OR .66, 95% CI .47, .94). SES does not mediate racial differences in receipt of definitive treatment or the type of definitive treatment received, and associations with income or employment status were not significant. </p><p><strong>Conclusions: </strong>These results stress the importance of examining racial disparities within geographic areas and highlight the unique associations that different measures of SES, particularly neighborhood SES and education, may have with prostate cancer treatment.</p><p><em>Ethn Dis. </em>2017;27(3):201-208; doi:10.18865/ed.27.3.201. </p>
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Sánchez, Elsa, Maria Gorgo-Gourovitch und Lee Stivers. „Creating a Sense of Belonging for Hispanic Farmers and Farmworkers in Agricultural Programming“. HortTechnology 29, Nr. 4 (August 2019): 476–81. http://dx.doi.org/10.21273/horttech04336-19.
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Hispanics residing in the United States are playing a larger role in agriculture. For example, in Pennsylvania, this group comprises the largest increase in new farmers, according to the 2012 Census of Agriculture. Efforts to connect with this population can be improved. Hispanic farmers and farmworkers face access barriers to agricultural programming that need to be addressed to more effectively “reach and teach.” Over a 1-year period, 22 to 25 agricultural educators attended a three-workshop training series focused on increasing knowledge and skills for planning, designing, advertising, and delivering agricultural programs inviting to Hispanic farmers and farmworkers. The workshop series included an expert on the science of inclusion, a specialist in Latino community studies, and several representatives from organizations with long histories of connecting with Hispanic farming audiences. Through guided activities and facilitated discussion, participants developed strategies for creating programming welcoming to the Hispanic farming community. This workshop series was highly rated by participants. After the first workshop, one participant stated that it was the best diversity workshop he had attended in his 22-year career. In a follow-up survey 1 year after the final workshop, the majority of respondents had made efforts to build relationships through agricultural programming for Hispanic farmers and farmworkers. Here, we are providing the methods we employed to serve as a model for others working to connect with this or other underserved or nontraditional farming audiences.
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Riley, John S., Valerie L. Luks, Luis Filipe de Pina, Ziad Al Adas, Jordan B. Stoecker, Benjamin M. Jackson, Benjamin M. Braslow und Daniel N. Holena. „COVID-19 Pandemic Significantly Decreases Acute Surgical Complaints“. American Surgeon 86, Nr. 11 (29.08.2020): 1492–500. http://dx.doi.org/10.1177/0003134820949506.
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Background The coronavirus disease 2019 (COVID-19) pandemic significantly reduced elective surgery in the United States, but the impact of COVID-19 on acute surgical complaints and acute care surgery is unknown. Study design A retrospective review was performed of all surgical consults at the Hospital of the University of Pennsylvania in the 30 days prior to and 30 days following confirmation of the first COVID-19 patient at the institution. Consults to all divisions within general surgery were included. Results Total surgical consult volume decreased by 43% in the post-COVID-19 period, with a significant reduction in the median daily consult volume from 14 to 8 ( P < .0001). Changes in consult volume by patient location, chief complaint, and surgical division were variable, in aggregate reflecting a disproportionate decrease among less acute surgical complaints. The percentage of consults resulting in surgical intervention remained equal in the 2 periods (31% vs 28%, odds ratio 0.85, 95% CI 0.61-1.21, P = .38) with most but not all operation types decreasing in frequency. The rise in the COVID-19 inpatient census led to increased consultation for vascular access, accommodated at our center by the creation of a new surgical procedures team. Conclusion The COVID-19 pandemic significantly altered the landscape of acute surgical complaints at our large academic hospital. An appreciation of these trends may be helpful to other Departments of Surgery around the country as they deploy staff and allocate resources in the COVID-19 era.
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Poulsen, Melissa N., Annemarie G. Hirsch, Lorraine Dean, Jonathan Pollak, Joseph DeWalle, Katherine Moon, Meghann Reeder, Karen Bandeen-Roche und Brian S. Schwartz. „Community credit scores and community socioeconomic deprivation in association with type 2 diabetes across an urban to rural spectrum in Pennsylvania: a case–control study“. BMJ Public Health 2, Nr. 1 (März 2024): e000744. http://dx.doi.org/10.1136/bmjph-2023-000744.
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BackgroundArea-level credit scores (the mean of credit scores for persons in a community) may be a unique indicator of community-level socioeconomic conditions associated with health outcomes. We analysed community credit scores (CCS) in association with new onset type 2 diabetes (T2D) across a geographically heterogeneous region of Pennsylvania and evaluated whether associations were independent of community socioeconomic deprivation (CSD), which is known to be related to T2D risk.MethodsIn a nested case–control study, we used medical records to identify 15 888 T2D cases from diabetes diagnoses, medication orders and laboratory test results and 79 435 diabetes-free controls frequency matched on age, sex and encounter year. CCS was derived from Equifax VantageScore V.1.0 data and categorised as ‘good’, ‘high fair’, ‘low fair’ and ‘poor’. Individuals were geocoded and assigned the CCS of their residential community. Logistic regression models adjusted for confounding variables and stratified by community type (townships (rural/suburban), boroughs (small towns) and city census tracts). Independent associations of CSD were assessed through models stratified by high/low CSD and high/low CCS.ResultsCompared with individuals in communities with ‘high fair’ CCS, those with ‘good’ CCS had lower T2D odds (42%, 24% and 12% lower odds in cities, boroughs and townships, respectively). Stratified models assessing independent effects of CCS and CSD showed mainly consistent associations, indicating each community-level measure was independently associated with T2D.ConclusionCCS may capture novel, health-salient aspects of community socioeconomic conditions, though questions remain regarding the mechanisms by which it influences T2D and how these differ from CSD.
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Wiese, Daniel, Kevin A. Henry, Carolyn Fang, Adam Reese, Mary Daly, Camille Ragin und Shannon M. Lynch. „Abstract A018: Geographic disparities in aggressive prostate cancer varies by region-specific environmental and sociodemographic characteristics: A statewide analysis“. Cancer Epidemiology, Biomarkers & Prevention 32, Nr. 1_Supplement (01.01.2023): A018. http://dx.doi.org/10.1158/1538-7755.disp22-a018.
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Abstract Background: Although the overall 5-year survival rate for prostate cancer (PCa) is relatively high, there are substantial differences in survival by stage at diagnosis. In contrast to men diagnosed with localized or regional stage PCa, both of which have a 5-year survival rate of nearly 100%, only 31% of patients survive five years after being diagnosed with distant or metastatic disease. Given PCa remains the second leading cause of cancer death among U.S. men, targeted PCa screening interventions centered on early detection for men at risk for more aggressive PCa subtypes appear warranted. Under a Precision Public Health approach, the application of geospatial analysis to cancer surveillance data can help to identify and “narrow down” geographic areas where rates of aggressive PCa are higher than expected to target for intervention. Thus, the primary objective of this study was to conduct a geospatial scan to identify clusters of aggressive PCa in a State-wide analysis. Given well-known racial disparities and associations between socioeconomic status and PCa stage at diagnosis and survival, the secondary objective was to evaluate geographic variation, or changes in aggressive PCa clusters, by area-level sociodemographics and environmental exposures. Methods: The study population included 82,580 patients diagnosed with incident PCa from the Pennsylvania (PA) State Registry from 2005-2015. Patient addresses were geocoded. Patient clinical data from the registry (age, race/ethnicity, insurance status) were linked via geocodes to area-level sociodemographic measures generated from the US Census Bureau at the census tract level, and to Environmental Quality Indices (Air, water, soil) from the Environmental Protection Agency (EPA) at the county level. Aggressive PCa was evaluated using 3 separate definitions based on TNM staging and/or Gleason grade. A Bayesian geoadditive modeling approach identified census tract clusters with higher than expected rates of aggressive PCa, adjusted for individual-level factors (age, race, diagnosis year) (Baseline model). The baseline model was then compared to models that included sociodemographic and/or environmental measures by evaluating changes in model fit (DIC), cluster size, and relative risk (RR). Results: We identified 3 main clusters in PA where rates of aggressive PCa were higher than expected near Philadelphia, Altoona, and Pittsburgh. Clusters of aggressive PCa in Philadelphia were eliminated and could be fully explained after adjustment for sociodemographic characteristics (insurance, poverty, etc), but not environmental measures. In contract, clusters of aggressive PCa in Pittsburgh were only reduced after adjustment for environmental variables, particularly water quality. Conclusion: PCa screening interventions could be prioritized in high risk cluster areas. Results are novel in that they preliminarily suggest that the type of intervention and focus of future etiologic studies in aggressive PCa might vary by geographic location, even within a single State. Citation Format: Daniel Wiese, Kevin A. Henry, Carolyn Fang, Adam Reese, Mary Daly, Camille Ragin, Shannon M. Lynch. Geographic disparities in aggressive prostate cancer varies by region-specific environmental and sociodemographic characteristics: A statewide analysis [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A018.
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Thorpe, Lorna E., Samrachana Adhikari, Priscilla Lopez, Rania Kanchi, Leslie A. McClure, Annemarie G. Hirsch, Carrie R. Howell et al. „Neighborhood Socioeconomic Environment and Risk of Type 2 Diabetes: Associations and Mediation Through Food Environment Pathways in Three Independent Study Samples“. Diabetes Care 45, Nr. 4 (01.02.2022): 798–810. http://dx.doi.org/10.2337/dc21-1693.
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OBJECTIVE We examined whether relative availability of fast-food restaurants and supermarkets mediates the association between worse neighborhood socioeconomic conditions and risk of developing type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS As part of the Diabetes Location, Environmental Attributes, and Disparities Network, three academic institutions used harmonized environmental data sources and analytic methods in three distinct study samples: 1) the Veterans Administration Diabetes Risk (VADR) cohort, a national administrative cohort of 4.1 million diabetes-free veterans developed using electronic health records (EHRs); 2) Reasons for Geographic and Racial Differences in Stroke (REGARDS), a longitudinal, epidemiologic cohort with Stroke Belt region oversampling (N = 11,208); and 3) Geisinger/Johns Hopkins University (G/JHU), an EHR-based, nested case-control study of 15,888 patients with new-onset T2D and of matched control participants in Pennsylvania. A census tract–level measure of neighborhood socioeconomic environment (NSEE) was developed as a community type-specific z-score sum. Baseline food-environment mediators included percentages of 1) fast-food restaurants and 2) food retail establishments that are supermarkets. Natural direct and indirect mediating effects were modeled; results were stratified across four community types: higher-density urban, lower-density urban, suburban/small town, and rural. RESULTS Across studies, worse NSEE was associated with higher T2D risk. In VADR, relative availability of fast-food restaurants and supermarkets was positively and negatively associated with T2D, respectively, whereas associations in REGARDS and G/JHU geographies were mixed. Mediation results suggested that little to none of the NSEE–diabetes associations were mediated through food-environment pathways. CONCLUSIONS Worse neighborhood socioeconomic conditions were associated with higher T2D risk, yet associations are likely not mediated through food-environment pathways.
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Moon, Katherine A., Cara M. Nordberg, Stephanie L. Orstad, Aowen Zhu, Jalal Uddin, Priscilla Lopez, Mark D. Schwartz et al. „Mediation of an association between neighborhood socioeconomic environment and type 2 diabetes through the leisure-time physical activity environment in an analysis of three independent samples“. BMJ Open Diabetes Research & Care 11, Nr. 2 (März 2023): e003120. http://dx.doi.org/10.1136/bmjdrc-2022-003120.
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IntroductionInequitable access to leisure-time physical activity (LTPA) resources may explain geographic disparities in type 2 diabetes (T2D). We evaluated whether the neighborhood socioeconomic environment (NSEE) affects T2D through the LTPA environment.Research design and methodsWe conducted analyses in three study samples: the national Veterans Administration Diabetes Risk (VADR) cohort comprising electronic health records (EHR) of 4.1 million T2D-free veterans, the national prospective cohort REasons for Geographic and Racial Differences in Stroke (REGARDS) (11 208 T2D free), and a case–control study of Geisinger EHR in Pennsylvania (15 888 T2D cases). New-onset T2D was defined using diagnoses, laboratory and medication data. We harmonized neighborhood-level variables, including exposure, confounders, and effect modifiers. We measured NSEE with a summary index of six census tract indicators. The LTPA environment was measured by physical activity (PA) facility (gyms and other commercial facilities) density within street network buffers and population-weighted distance to parks. We estimated natural direct and indirect effects for each mediator stratified by community type.ResultsThe magnitudes of the indirect effects were generally small, and the direction of the indirect effects differed by community type and study sample. The most consistent findings were for mediation via PA facility density in rural communities, where we observed positive indirect effects (differences in T2D incidence rates (95% CI) comparing the highest versus lowest quartiles of NSEE, multiplied by 100) of 1.53 (0.25, 3.05) in REGARDS and 0.0066 (0.0038, 0.0099) in VADR. No mediation was evident in Geisinger.ConclusionsPA facility density and distance to parks did not substantially mediate the relation between NSEE and T2D. Our heterogeneous results suggest that approaches to reduce T2D through changes to the LTPA environment require local tailoring.
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Hodges, Alan W., Charles R. Hall und Marco A. Palma. „Economic Contributions of the Green Industry in the United States in 2007–08“. HortTechnology 21, Nr. 5 (Oktober 2011): 628–38. http://dx.doi.org/10.21273/horttech.21.5.628.
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Economic contributions of the green industry in each state of the United States were estimated for 2007–08 using regional economic multipliers, together with information on horticulture product sales, employment, and payroll reported by the U.S. Economic Census and a nursery industry survey. Total sales revenues for all sectors were $176.11 billion, direct output was $117.40 billion, and total output impacts, including indirect and induced regional economic multiplier effects of nonlocal output, were $175.26 billion. The total value added impact was $107.16 billion, including employee compensation, proprietor (business owner) income, other property income, and indirect business taxes paid to state/local and federal governments. The industry had direct employment of 1.20 million full-time and part-time jobs and total employment impacts of 1.95 million jobs in the broader economy. The largest individual industry sectors in terms of employment and value added impacts were Landscaping services (1,075,343 jobs, $50.3 billion), Nursery and greenhouse production (436,462 jobs, $27.1 billion), and Building materials and garden equipment and supplies stores (190,839 jobs, $9.7 billion). The top 10 individual states in terms of employment contributions were California (257,885 jobs), Florida (188,437 jobs), Texas (82,113 jobs), North Carolina (81,113 jobs), Ohio (79,707 jobs), Pennsylvania (75,604 jobs), New Jersey (67,993 jobs), Illinois (67,382 jobs), Georgia (66,042 jobs), and Virginia (58,677 jobs). The total value added of the U.S. green industry represented 0.76% of U.S. Gross Domestic Product (GDP) in 2007, and up to 1.60% of GDP in individual states. On the basis of a similar previous study for 2002 (Hall et al., 2006), total sales of horticultural products and services in 2007–08 increased by 3.5%, and total output impacts increased by 29.2%, or an average annual rate of 5.8% in inflation-adjusted terms.
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Haadi, Ali, Justin Kosman, Shane Bross, Jesse Manikowski, Bradley Hinger, Andrew Conger, Joseph Vadakara und Na Tosha Gatson. „EPID-34. GEODEMOGRAPHIC CLASSIFICATION OF GLIOBLASTOMA RISK IN A RURAL HOSPITAL SYSTEM: RELATIONSHIP TO TUMOR INCIDENCE AND OVERALL SURVIVAL“. Neuro-Oncology 21, Supplement_6 (November 2019): vi82. http://dx.doi.org/10.1093/neuonc/noz175.334.
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Abstract In 2019, a projected 86,000 persons in the US will be diagnosed with a primary brain tumor, with an estimated prevalence of 700,000. Glioblastoma (GBM) is the deadliest and most common of these tumors in adults with an overall survival ~15 months. Exposure to ionizing radiation is the single known environmental risk factor for GBM. Most research in the field is directed at treatment and tumor biology/classification. There is growing interest in geodemographics, disease prevention, and measuring quality-survival in GBM. We evaluated 622 GBM patients (2006 to 2018) in Northeastern/Northcentral Pennsylvania treated at one of the nation’s largest rural hospital systems. Each patient was geocoded (plotted longitude/latitude) address at time of diagnosis and we used medical records, projected 2015 Census, and Environmental Protection Agency data to develop risk maps. Preliminary evaluation of overall survival (OS) and incidence related to distance from hospital, age, sex, level of education, insurance, income, and income disparity (Gini coefficient measure of income inequality) was completed. Interestingly, all significant clusters of high GBM incidence lay along water-ways or overlapped with high coal mine reprocessing. Contrary to recent studies, there was no significant sex or distance (0mi to 150mi) impact on survival. However, each age-decile increase resulted in an average 9mo decrease in OS (37mo[< 40yo], 26mo [41-50yo], 17mo [51-60yo], 12mo [61-70yo], and 3mo [>71yo]). Counties with the lowest OS shared geodemographic characteristics such as fewer insured and lower incomes (low income inequality), and counties with more college educated persons had longer survival. Counties with higher GBM incidences had better insured percentages, lower incomes (high income inequality), and large polarity between high school uneducated and college educated persons. Rural populations potentially demonstrate unique geodemographic characteristics that might better predict disease outcomes. Studies in this area could influence improvements in public policy and prevention-focused health literacy opportunities.
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Taylor, Janielle, Yongli Shuai, Linda Robertson, Daniel Paul Normolle, Robert L. Ferris, Todd Bear, Marci Lee Nilsen et al. „The effect of locality of residence (LOR) and socioeconomic status (SES) on mortality in patients with squamous cell carcinoma of the head and neck (HNSCC): 20-year experience at the UPMC Hillman Cancer Center.“ Journal of Clinical Oncology 38, Nr. 15_suppl (20.05.2020): e19043-e19043. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e19043.
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e19043 Background: As cancer centers expand, evaluation of potential disparities in outcomes amongst the catchment area is critically important. We examined the effect of LOR and SES on overall survival (OS) in HNSCC patients treated at HCC, which spans 29 counties in western Pennsylvania with diverse socioeconomic profiles across urban and rural localities. Methods: Retrospective review included patients with primary HNSCC (excluding M1 and recurrent disease) treated at HCC 1997-2018. Using Rural-Urban Commuting Area codes, LOR was classified as urban/suburban or rural according to ZIP code. SES was defined by medium income level (low, moderate (Mod), middle (Mid), Upper) via Federal Financial Institutions Examination Council geocoded census tract data. Kaplan-Meier methods and Cox regression models were used to evaluate OS. Results: 3512 patients were identified. Median age was 61, 72.7% male, 93.2% White, 18% HPV +, 75.5% urban/suburban, and by SES: 4% Low, 21% Mod, 46% Mid, and 19% Upper. Primary site included 35.2% oral cavity, 28.4% oropharynx, 28.1% larynx, 8.3% other, stage was majority III/IVa (61%), 66% had surgery and 54% received multimodality treatment (tx). While median OS differed significantly by race (Black: 5.8 vs. White: 7.3 years, p = 0.0457) and SES (Low: 4.1 vs. Mod: 5.3 vs. Mid: 7.3 vs. Upper: 9.1 years, p < 0.0001), there was no difference by LOR (rural: 7.7 vs. urban/suburban: 7.2 years, p = 0.99). Multivariable Cox Regression showed lower SES was associated with a higher risk of death [(Low vs. Upper, HR: 1.416, 95% CI: 1.023-1.959) (Mod vs. Upper, HR:1.443, 95% CI: 1.214 – 1.716), p = 0.0004], adjusting for LOR and factors associated with OS in univariate analysis (age, smoking status, primary site, staging, tx, HPV status, race, and enrollment on clinical trial). The effect of LOR, race, and enrollment on clinical trial were not significant in multivariate analysis. Conclusions: SES was independently associated with OS in HNSCC patients treated at HCC, while LOR was not associated with OS. The lack of difference by LOR may be partially explained by HCC’s efforts to increase access to care throughout the catchment area by establishing community sites. However, a focus on improving outcomes for lower SES HNSCC patients is needed.
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Gobaud, Ariana N., Christina A. Mehranbod, Elinore Kaufman, Jonathan Jay, Jessica H. Beard, Sara F. Jacoby, Charles C. Branas, Brady Bushover und Christopher N. Morrison. „Assessing the Gun Violence Archive as an Epidemiologic Data Source for Community Firearm Violence in 4 US Cities“. JAMA Network Open 6, Nr. 6 (02.06.2023): e2316545. http://dx.doi.org/10.1001/jamanetworkopen.2023.16545.
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ImportanceFirearm injury is a major public health burden in the US, and yet there is no single, validated national data source to study community firearm violence, including firearm homicide and nonfatal shootings that result from interpersonal violence.ObjectiveTo assess the validity of the Gun Violence Archive as a source of data on events of community firearm violence and to examine the characteristics of individuals injured in shootings.Design, Setting, and ParticipantsThis cross-sectional observational study compared data on community firearm violence from the Gun Violence Archive with publicly available police department data, which were assumed to be the reference standard, between January 1, 2015, and December 31, 2020. Cities included in the study (Philadelphia, Pennsylvania; New York, New York; Chicago, Illinois; and Cincinnati, Ohio) had a population of greater than 300 000 people according to the 2020 US Census and had publicly available shooting data from the city police department. A large city was defined as having a population greater than or equal to 500 000 (ie, Philadelphia, New York City, and Chicago). Data analysis was performed in December 2022.Main Outcomes and MeasuresEvents of community firearm violence from the Gun Violence Archive were matched to police department shootings by date and location. The sensitivity and positive predictive value of the data were calculated (0.9-1.0, excellent; 0.8-0.9, good; 0.7-0.8, fair; 0.6-0.7, poor; and &lt;0.6, failed).ResultsA total of 26 679 and 32 588 shooting events were documented in the Gun Violence Archive and the police department databases, respectively, during the study period. The overall sensitivity of the Gun Violence Archive over the 6-year period was 81.1%, and the positive predictive value was 99.0%. The sensitivity steadily improved over time. Shootings involving multiple individuals and those involving women and children were less likely to be missing from the Gun Violence Archive, suggesting a systematic missingness.Conclusions and RelevanceThese findings support the use of the Gun Violence Archive in large cities for research requiring its unique advantages (ie, spatial resolution, timeliness, and geographic coverage), albeit with caution regarding a more granular examination of epidemiology given its apparent bias toward shootings involving multiple persons and those involving women and children.
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Prussien, Kemar V., Andrea H. Roe, Veronica Bochenek, Jessica Wu, Sandy Luz, Seema Bhatnagar und Kandace Gollomp. „Socioeconomic and Inflammatory Correlates of Plasma Cortisol Among Individuals with Sickle Cell Disease“. Blood 142, Supplement 1 (28.11.2023): 3893. http://dx.doi.org/10.1182/blood-2023-181918.
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Introduction: Cortisol plays a critical role in the biological link between stress and health outcomes. It is frequently investigated in the association between socioeconomic stress and morbidity, and the hypothesized biological mechanism by which socioeconomic stress and cortisol impact health is through chronically elevated systemic inflammation. This research is relevant to individuals with sickle cell disease (SCD) for several reasons. First, up to 40% of children and adolescents with SCD are impacted by neighborhood poverty. Furthermore, individuals with SCD are faced with significant disease-related morbidities, such as chronic and acute pain, renal injury, and cerebrovascular disease that are further complicated by elevated inflammatory markers. Finally, cortisol is heavily understudied in this population, with no research investigating socioeconomic or inflammatory correlates. The purpose of this study was to investigate plasma cortisol and its association with neighborhood-level socioeconomic factors (income and poverty) and immunomodulatory cytokines (IL-6, IL-10), among individuals with SCD. Method: Plasma from individuals with SCD within Children's Hospital of Philadelphia (CHOP) and University of Pennsylvania School of Medicine (Penn Medicine) BioBanks were identified. A cortisol radioimmunoassay was used to determine plasma cortisol levels. The Olink immune response panel was used to measure plasma levels of 92 proteins involved in inflammatory pathways. Home address collected from electronic health records was used to determine neighborhood census tract geoid, which was then used to collect data on median neighborhood income and percentage of families living in poverty from the 2020 American Census Survey. Bivariate and multivariate analyses were conducted across 4 subgroups in the total sample: pediatric patients, adult patients, SCA (HbSS/HbSß 0), and other SCD genotypes (HbSC/HbSß +). Control samples (healthy and sickle cell trait; n = 22) without neighborhood information were also available for comparison. Results: Fifty-four independent outpatient samples were identified after excluding duplicates and siblings. Twenty-seven samples were from children and adolescents receiving pediatric care at CHOP (Range age = .8 to 21; Mage= 13.6, SD = 5.3; 51.9% female, 74.1% SCA) and 27 samples were from adults receiving care at Penn Medicine (Range age = 19 to 56; Mage= 35.8, SD = 10.1; 51.9% female, 51.9% SCA). There were no significant differences in cortisol levels across each subgroup ( Mpeds= 16.6, SDpeds = 6.2; Madult= 13.4, SDadult = 6.9; MSCA= 15.1, SDSCA = 7.1; MSCD= 14.9, SDSCD = 6.3). Neighborhood income and poverty did not differ across pediatric and adult patients, and income did not differ across SCD types. However, neighborhood poverty was lower among patients with SCA ( M = 13.9; SD = 11.9) relative to other SCD genotypes ( M = 21.7; SD = 13.5; p = .041). Bivariate Spearman analyses found that neighborhood variables were not correlated with cortisol or cytokines in the total sample or subgroups. Yet, multivariate analyses controlling for sex and time of blood draw showed a positive main effect for patient age ( p = .019) and a significant age by poverty interaction ( p = .041) predicting cortisol among pediatric patients. Cortisol levels were higher with age, yet the association among poverty and cortisol was strongest in younger patients. Analyses also showed a sex*poverty interaction among pediatric patients that approached significance ( p = .081), such that poverty only predicted cortisol in male patients. There were no significant differences for immunomodulatory cytokines across each SCD subgroups; however, IL-6 and IL-10 were elevated in patients with SCA relative to healthy controls ( p IL6 = .021; p IL10 = .003). Bivariate Spearman correlations showed that cortisol was positively related to IL-6 (rho [ρ]= .38, p = .027) and IL-10 (ρ= .34, p = .048) among patients with SCA. There were no additional significant bivariate or multivariate effects. Conclusion: Neighborhood factors likely have downstream effects on the biological stress response and inflammation in SCD. Further research must be conducted to elucidate concurrent and prospective associations among neighborhood socioeconomic factors, stress-related cortisol response, and inflammatory outcomes when extending this work to investigate the impact of stress on SCD morbidity and mortality.
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Treanor, William. „The Case of the Dishonest Scrivener: Gouverneur Morris and the Creation of the Federalist Constitution“. Michigan Law Review, Nr. 120.1 (2021): 1. http://dx.doi.org/10.36644/mlr.120.1.case.
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At the end of the Constitutional Convention, the delegates appointed the Committee of Style and Arrangement to bring together the textual provisions that the Convention had previously agreed to and to prepare a final constitution. Pennsylvania delegate Gouverneur Morris drafted the document for the Committee, and, with few revisions and little debate, the Convention adopted Morris’s draft. For more than two hundred years, questions have been raised as to whether Morris covertly altered the text in order to advance his constitutional vision, but modern legal scholars and historians studying the Convention have either ignored the issue or concluded that Morris was an honest scrivener. No prior article has systematically compared the Committee’s draft to the previously adopted resolutions or discussed the implications of those changes for constitutional law. This Article undertakes that comparison. It shows that Morris made fifteen significant changes to the Constitution and that many of the Constitution’s central elements were wholly or in critical part Morris’s work. Morris’s changes strengthened the national executive and judiciary, provided the textual basis for judicial review, increased presidential accountability through an expansive conception of impeachment, protected private property, mandated that the census report reflect “actual enumeration,” removed the constitutional text suggesting that slavery was just, and fought slavery’s spread. This Article also shows that Morris created the basis for the Federalist reading of the Constitution. Federalists—notably including fellow Committee member Alexander Hamilton—repeatedly drew on language crafted by Morris as they fought for their vision of the Constitution. Because the changes Morris made to the Convention’s agreed language were subtle, both Republicans and Federalists were able to appeal to text in the great constitutional battles of the early republic. Modern originalists claim that the Republican reading reflects the original understanding of the Constitution, but this Article argues that the largely dismissed Federalist reading explains words, phrases, and punctuation that the Republican reading ignores or renders unintelligible. By contrast, the Federalist reading of the Preamble (which they saw as a grant of substantive power), the Article I and Article II Vesting Clauses (which were contrasted to argue for expansive executive power), the Article III Vesting Clause (which they read to mandate the creation of lower federal courts), the Contracts Clause (which they read to cover public as well as private contracts), the Impeachment Clause (which they read to cover both nonofficial and official acts), and the “law of the land” provision (which they construed as a basis for judicial review) gives effect to Morris’s—and the Constitution’s—words.
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Dolney, Timothy J. „A GIS Methodology for Assessing the Safety Hazards of Abandoned Mine Lands (AMLs)“. International Journal of Applied Geospatial Research 2, Nr. 3 (Juli 2011): 50–71. http://dx.doi.org/10.4018/jagr.2011070104.
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Abandoned mine lands (AMLs) associated with past coal-mining scar Pennsylvania’s landscape with environmental and safety hazards. Reclamation projects eliminate and reduce hazards AMLs pose. Due to the large number of AMLs and limited funds, precedence is given to reclaim the most hazardous sites first. These sites are identified through an assessment process that assigns priorities to AMLs. However, priorities are out-dated and do not accurately reflect the current spatial distribution of land use and census data. This article presents a GIS methodology for the prioritization of AMLs using the process of extrapolation and focal statistics. By incorporating current assessment techniques into GIS with current land use and census data, AML priorities were reassigned to accurately reflect the current spatial landscape. Results indicate that current AML priorities assigned by the state do not accurately reflect current land use and census data and underestimate the safety hazards of many sites, including high priority sites.
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Shahzad, Moazzam, Muhammad Fareed Khalid, Ahmad Basharat, Atif Butt, Sakina Abbas, Hovra Zahoor, Fizza Mohsin et al. „Geographic and Racial Disparities in Chimeric Antigen Receptor-T Cells and Bispecific Antibodies Trials Access for Diffuse Large B-Cell Lymphoma“. Blood 142, Supplement 1 (28.11.2023): 2414. http://dx.doi.org/10.1182/blood-2023-172935.
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Introduction: The number of clinical trials of chimeric antigen receptor T- cell (CAR-T) therapy and bispecific antibodies to treat diffuse large B-cell lymphoma (DLBCL) has increased exponentially. However, there is geographic limitation to offering these trial and universal access appears to be limited especially for minorities and those in low socioeconomic stratum. Here, we investigate the geographical and racial disparities in accessing CAR-T cell therapy and bispecific antibodies trials for DLBCL. Methods: Data on clinical trials were obtained from ClinicalTrials.gov, the largest clinical trials registry database that provides data on clinical trials that are completed or in process. We searched ClinicalTrials.gov in May 2023 using the terms diffuse large B-cell lymphoma, DLBCL, CAR-T, chimeric antigen receptor T cells, chimeric, bispecific antibodies, bispecific, BCMA, and T-cell engager. All available trials listed as completed, recruiting, active-nonrecruiting, terminated, or suspended. The collected data abstracted from ClinicalTrials.gov included study titles, National Clinical Trial identification numbers, trial phase and intervention, actual or expected number of participants (in studies that did not complete enrollment), primary outcomes, recruiting sites, funders, and specific inclusion and exclusion criteria. 2020 United States (US) Census Bureau data was used to obtain data on race and ethnicity. Analysis for this study was performed using SPSS version 26. Results: A total of 76 out of 133 clinical trials with one or more open site in the US were included for this systematic review. There were 63 (82.9%) CAR-T therapy and 13 (17.1%) bispecific antibodies trials. A total of 166823 participants were either enrolled or expected to enroll in these clinical trials including 165938 (99.5%) of CAR-T and 885 (0.5%) bispecific antibodies clinical trials participants. Sixty-five (85.5%) clinical trials were only open in the US while 11 (14.5%) clinical trials were open in the US and other countries. The majority of the trials 49 (64.5%) were funded by the industry, while 27 (35.5%) were non-industry sponsored. The primary outcomes of the studies were safety related, efficacy related, and both safety and efficacy related in 43 (56.6%), 22 (28.9%), and 11 (14.5%) trials, respectively. One hundred and twenty-six unique study sites for the 76 analyzed clinical trials were identified. The mean number of sites per trial were 4.5 (1-26) for CAR-T trials and 4.4 (1-24) for bispecific antibodies. The study sites were distributed in 31 different states and mean number of trial per state were 11 (0-51). Most sites for trials were in Southern states 39 (31%), followed by Midwestern 32 (25.4%), Northeastern 30 (23.8%), and Western states 25 (19.8%). The highest number of study locations were in California (13), New York (9), and Pennsylvania (9) while the highest number of open studies were in California (51), Texas (32), and New York (23). Twenty states had no open CAR-T or bispecific antibodies clinical trials including three in the Northeast (Maine, Rhode Island, and Vermont), three in the Midwest (Indiana, North and South Dakota), seven in the South (Delaware, District of Columbia, West Virginia, Mississippi, Arkansas, Louisiana, and Oklahoma), and seven in the West (Idaho, New Mexico, Montana, Nevada, Wyoming, Alaska, and Hawaii). (Figure 1A) Using Census Bureau data, only 33.3% of the African American (AA) (13 669 915 of 41 104 200) lived in a county with a CAR-T or bispecific antibodies trial. There were only six states (12%) with 50% or more of the AA population living in a county with an open CAR-T or bispecific antibody trial and 15 states (29%) with 30% or more of their AA county residents. Seven out of ten states with the highest proportion of AA residents (18.6%-41.4%) have no (four states) or less than four clinical trial sites (three states) for either CAR-T or bispecific antibodies. (Figure 1B) Conclusion: There is significant geographic and racial disparity in accessing CAR-T cell therapy and bispecific antibodies trials for DLBCL. Strategies should be framed to address the causes for the observed disparities and to improve access.
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Kerwin, Donald, Daniela Alulema, Michael Nicholson und Robert Warren. „Statelessness in the United States: A Study to Estimate and Profile the US Stateless Population“. Journal on Migration and Human Security 8, Nr. 2 (Juni 2020): 150–213. http://dx.doi.org/10.1177/2331502420907028.
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Executive Summary In October 2017, the Center for Migration Studies of New York (CMS) initiated a study to map the stateless population in the United States. This study sought to: Develop a methodology to estimate the US stateless population; Provide provisional estimates and profiles of persons who are potentially stateless or potentially at risk of statelessness in the United States; Create a research methodology that encouraged stateless persons to come forward and join a growing network of persons committed to educating the public on and pursuing solutions to this problem; and Establish an empirical basis for public and private stakeholders to develop services, programs, and policy interventions to prevent and reduce statelessness (UNHCR 2014g, 6), and to safeguard the rights of stateless persons ( UNHCR 2014d ). This report describes a unique methodology to produce estimates and set forth the characteristics of US residents who are potentially stateless or potentially at risk of statelessness. The methodology relies on American Community Survey (ACS) data from the US Census Bureau, supplemented by very limited administrative data on stateless refugees and asylum seekers. 1 As part of the study, CMS developed extensive, well-documented profiles of non–US citizen residents who are potentially stateless or potentially at risk of statelessness. It then used these profiles to query ACS data to develop provisional estimates and determine the characteristics of these populations. The report finds that the population in the United States that is potentially stateless or potentially at risk of statelessness is larger and more diverse than previously assumed, albeit with the caveat that severe data limitations make it impossible to provide precise estimates of this population. Stateless determinations require individual screening, which the study could not undertake. Individuals deemed potentially stateless or potentially at risk of statelessness in this report may in fact have been able to secure nationality in their home countries or in third countries. They may also be on a path to citizenship in the United States, although nobody in CMS’s estimates had yet to obtain US citizenship. According to CMS’s analysis, roughly 218,000 US residents are potentially stateless or potentially at risk of statelessness. These groups live in all 50 states, 2 with the largest populations in California (20,600), New York (18,500), Texas (15,200), Ohio (13,200), Minnesota (11,200), Illinois (8,600), Pennsylvania (8,200), Wisconsin (7,300), Georgia (6,600), and Virginia (6,500). The report recommends ways to improve data collection and, thus, develop better estimates in the future. It also lifts up the voices and challenges of stateless persons, and outlines steps to reduce statelessness and safeguard the rights of stateless persons in the United States. As it stands, the paucity of reliable federal data on the stateless, the lack of a designated path to legal status for them under US law, and the indifference of government agencies contribute to the vulnerability and isolation of these populations.
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Patterson, Brandon J., Philip O. Buck, Justin Carrico, Katherine A. Hicks, Desmond Curran, Desiree Van Oorschot, John E. Pawlowski, Bruce Y. Lee und Barbara P. Yawn. „Assessment of the Potential Herpes Zoster and Post Herpetic Neuralgia Case Avoidance with Vaccination in the United States“. Open Forum Infectious Diseases 4, suppl_1 (2017): S413. http://dx.doi.org/10.1093/ofid/ofx163.1034.
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Abstract Background Herpes zoster (HZ), commonly referred to as shingles, is a reactivation of latent varicella zoster virus in patients previously infected. Clinical characteristics of HZ include painful rash with potential complications, including post herpetic neuralgia (PHN). Care for HZ and PHN incurs significant costs and vaccination is beneficial. The aim of this study was to compare the impact on HZ and PHN case avoidance of two HZ vaccines, an available live-attenuated zoster vaccine (zoster vaccine live [ZVL]) vs. a candidate non-live adjuvanted HZ subunit vaccine (HZ/su), in the US population. Methods A Markov model called ZONA (ZOster ecoNomic Analyses) was developed following two age cohorts (≥60 years to represent the current ACIP recommendation and ≥65 years to represent the Medicare population) over their lifetimes from the year of vaccination. Demographic data were obtained from the US Census, whereas HZ incidence and the proportion of HZ individuals developing PHN were derived from published US-specific sources. Age-specific vaccine efficacy and waning rates were based on published clinical trial data. Vaccine coverage for both vaccines was assumed to be 30.6% and 34.2% in the two age cohorts, respectively, based on CDC data; compliance of the second dose of the HZ/su vaccine was 69%, based on data from clinical trials and Hepatitis B seconddose completion. Sensitivity analyses demonstrated robustness of the base analysis findings. Results In the US, for cohorts of 66.83 million (M) persons aged 60+ and 47.76M aged 65+ it was estimated that the HZ/su vaccine would reduce the number of HZ cases by 2.12M and 1.55M in the two age cohorts, respectively, compared with 0.65M and 0.45M using the ZVL. Furthermore, the HZ/su vaccine would reduce the number of PHN cases by 0.23M and 0.18M in the two age cohorts, respectively, compared with 0.10M and 0.09 using the ZVL. The number needed to vaccinate to prevent one HZ case were 10 and 11, in the respective cohorts, using the HZ/su vaccine compared with 31 and 37, in the respective cohorts, using the ZVL. Conclusion Due to higher and sustained vaccine efficacy, the candidate HZ/su vaccine demonstrated superior public health impact in the US compared with the currently available ZVL. Disclosures B. J. Patterson, GSK: Employee and Shareholder, GSK stock options or restricted shares and Salary; Pennsylvania Pharmacists Association: Scientific Advisor, stipend; P. O. Buck, GSK: Employee and Shareholder, GSK stock options or restricted shares and Salary; J. Carrico, RTI Health Solutions: Employee, Salary GSK: Research Contractor, Research support; K. A. Hicks, RTI: Employee, Salary GSK: Research Contractor, Research support; D. Curran, GSK: Employee and Shareholder, GSK stock options or restricted shares and Salary; D. Van Oorschot, GSK: Employee, Salary; J. E. Pawlowski, GSK: Employee and Shareholder, GSK stock options or restricted shares and Salary; B. Y. Lee, GSK: Consultant, Consulting fee; B. P. Yawn, GSK: Consultant and Scientific Advisor, Consulting fee